Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT May 2, 2003 "The reward for work well done is the opportunity to do more." - Jonas Salk, MD
Short Subjects
LINKS Mental Health Moment Online CONFERENCES AND WORKSHOPS:
Disaster Mental Health Services-I (DMHS-I)
(Red Cross Course)
Location: Salt Lake City, UT
Dates: May 6-7, 2003
Contact: Lucy Houser
Email: houserlc@crossnet.org
The Australasian Critical Incident
Stress Association Conference
The Right Response in the
21st Century
Location: Carlton Crest Hotel
Melbourne Australia
Friday October 3, 2003 thru
Sunday October 5, 2003
For further information
please contact the conference organisers:
ammp@optushome.com.au
Conference Website:
http://www.acisa.org.au/ conference2003/Summer Intensive Program
Graduate Certificate in
Disaster Mental Health
Disaster Mental Health Institute (University of South Dakota)
Location: Union Building
University of South Dakota Campus Vermillion, SD
Contact: Disaster Mental Health Institute
University of South Dakota
SDU 114 414 East Clark St
Vermillion, SD 57069-2390
Phone: 605-677-6575 or 800-522-9684
Fax: 605-677-6604
http://www.usd.edu/dmhi/Third Biennial International Conference
on Intercultural Research (IAIR)
May 16 - 19, 2003
Location: Taipei, Taiwan Contact: 2003 IAIR International Conference
C/o College of Education
NTNU, PO Box 7-763
Taipei, Taiwan 106
Tel: +(886)2-2321-3142
Fax +(886)2-2394-9243
Email: t14004@cc.ntnu.edu.tw
VIII European Conference
on Traumatic Stress(ECOTS)
May 22 - 25, 2003
Location: Berlin, GERMANY
Contact: Scientific Secretariat
VIII ECOTS Berlin 2003
c/o Catholic University of
Applied Social Sciences
Koepenicker Allee 39-57
D-10318 Berlin
Tel: +49-30-50 10 10 54
Fax: +49-30-50 10 10 88
E-mail: trauma-conference@kfb-berlin.de
6th Annual Conference
The University of South Dakota
Disaster Mental Health Institute
"Innovations in Disaster Psychology:
Time for a New Paradigm?
Reflecting on the Past:
Looking to the Future"
Radisson Hotel
Rapid City, SD
September 18-20, 2003
PUERTO RICO GETS $66 MILLION HURRICANE GRANT
The Federal Emergency Management Agency (FEMA) approved $66 million to the Puerto Rico Electric Power Authority (PREPA), to protect the Metropolitan zone’s electric power system from high wind forces in a future hurricane event. For the full story, go to: http://www.fema.gov/nwz03/nwz03_105.shtm
Expanded FEMA Spanish Web Site Launched
The Department of Homeland Security’s Federal Emergency Management Agency (FEMA) is unveiling an expanded Spanish Web site to provide the Spanish-speaking community with information about FEMA, disaster resources, preparedness articles, children’s books and links to other disaster-related sites in Spanish. For Full Story, go to: http://www.fema.gov/nwz03/nwz03_spanish.shtm
Security Council approves 1-year extension for UN mission in Afghanistan
28 March – Recognizing that the United Nations must continue to play its central and impartial role in efforts to assist the Afghan people to consolidate peace and rebuild their country, the Security Council today decided to extend the UN Assistance Mission in Afghanistan (UNAMA) for another 12 months. For The Full Story, go to: http://www.un.org/apps/news/story.asp?NewsID=6603&Cr=afghan&Cr1=
Thousands of Iraqi children will die unless they are made top priority – UNICEF
2 May – Thousands of Iraqi youngsters will die and hundreds of thousands more will be injured, fall prey to disease, suffer abuse and exploitation or fall behind in school, unless all involved in shaping the post-war future make the battle to protect children the number one priority, the United Nations Children’s Fund (UNICEF) warned today. FOR THE FULL STORY, go to: http://www.un.org/apps/news/story.asp?NewsID=6932&Cr=iraq&Cr1=relief
Student leaders, diplomats hold wide-ranging dialogue on UN's role in Iraq
2 May – More than 150 student leaders met today with members of the United Nations diplomatic community and UN officials for a unique dialogue to better understand issues related to conflict resolution, particularly the world body's role in Iraq, and other matters of global concern. FOR THE FULL STORY, go to: http://www.un.org/apps/news/story.asp?NewsID=6941&Cr=xxx&Cr1=
MOUSE RESEARCH SHEDS NEW LIGHT ON HUMAN GENETIC DISEASES
A team of researchers headed by Douglas R. Cavener, professor and head of the department of biology at Penn State, has announced new findings about the causes of three human diseases: severe, juvenile-onset diabetes; osteoporosis; and Wolcott-Rallison Syndrome, a rare condition whose sufferers exhibit a combination of diabetes, retarded growth and skeletal abnormalities. The work suggests promising lines of research for the therapeutic treatment of these diseases, and will be described in a forthcoming issue of the journal Endocrinology. Over several years, the team has developed and investigated a particular strain of "knockout" mice that are genetically unable to produce an enzyme involved in protein synthesis. Read the full story at http://live.psu.edu/index.php?cmd=vs&story=2828
THE MEDICAL MINUTE: SARS IS AN OLD VIRUS WITH A NEW TWIST
According to the latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical Center, the disease known as severe acute respiratory sydrome (SARS) is so new -- and the center of so much media attention -- that it's difficult to view it calmly. It has quickly become the health story of the moment, but SARS is actually an old virus with a new presentation. When Legionnaire's disease was first discovered, the lack of experience with it caused much fear. Similarly, AIDS was the source of much anxiety until it was better understood. SARS seems about as dangerous as influenza, and if they give it the same respect as influenza, people can better manage their concerns while researchers learn more about the virus itself. Read the full story at http://live.psu.edu/index.php?cmd=vs&story=2855
INTER-CULTURAL RELATIONSHIPS WORK BEST WHEN BOTH SIDES TREAT EACH OTHER AS EQUALS
"Why can't we all get along" is the often-cited phrase when national discussions focus on race relations, class divisions or gender differences. But men and women, whites and blacks, poor and rich, or disabled and able-bodied often bring pre-set ideas and expectations to the table, rather than an open mind. That precludes complete understanding, says a Penn State researcher. Read the full story at http://live.psu.edu/index.php?cmd=vs&story=2854
Major Disaster Declared For Alaska Winter Storm
Washington, D.C. -- Federal disaster aid has been made available to help people and communities in south central Alaska recover from the effects of a recent winter storm, the head of the Federal Emergency Management Agency (FEMA) announced today. For Full Story, go to: http://www.fema.gov/diz03/hq03_100.shtm
Rare Southern Quake Near Georgia-Alabama State Line Rattles Several States; 4.9 Magnitude
A rare earthquake shook parts of the South early Tuesday, rattling windows and awakening nervous residents but causing no reports of serious damage. The quake, which had a preliminary magnitude of 4.9, struck around 5 a.m. and was centered near Fort Payne, Ala., close to the Georgia line. For the Full Story, go to: http://www.fema.gov/press/ap/ap042903.shtm
TRAUMA POST-WAR
Reactions and responses to the trauma of war experiences have been studied and written about over the centuries and following most wars. Following each of the major conflicts of the twentieth century there was a flourish of studies that attempted to explain and deal with such trauma. In an early inter-war study that reviewed the causes of individual fear, Chavigny (1930) discussed the elements which compose it: the intellectual (the idea), the affective (suffering), the physical (the vaso-motor, visceral disturbances, etc.), and the active elements (effort). He then showed by a very extensive clinical documentation what fear is as found in armies. From these observations he concluded that such fear does not present any special characteristics. However, there is one additional observation that can sometimes be made. If the fear is engendered immediately after the emotional shock which caused it, there is in a certain number of cases a period of meditation, of maturation, which is analogous to that observed in cases of hysterical, post-traumatic accidents (Chavigny, 1930). The military and society in general have struggled with how to better prepare military personnel for the trauma of war as well as how best to re-integrate into society following conclusion of such conflicts.
As active duty forces continue to shrink in the post Cold War military, reserve and National Guard units play an increasingly important role in deployments of all types. When mobilized for deployment, reservists may experience a range of major life stressors in addition to the stressors encountered in the area of military operations. Although previous studies show ill effects of stress on some of these personnel, few studies have sought to explain the continued good health and stress resiliency displayed by the majority of veterans. Bartone (1999) examined personality hardiness as a potential protective variable among army reserve personnel mobilized for the Persian Gulf War. Regression results showed hardiness interacted with both combat-related stress and stressful life events to predict psychiatric symptoms on several measures. The pattern of results suggested hardiness protects against the ill effects of stress, particularly under high- and multiple-stress conditions. These results have implications for preventing the ill effects of stress across a variety of occupations that can expose workers to multiple stressors, including job disruption and family separation.
World War II
During and following World War II, a number of studies were done on what were termed posttraumatic neuroses. Posttraumatic neuroses were divided into fright and conflict neuroses. Fright neuroses were defined as developing under particularly harrowing circumstances, such as the campaign on Guadalcanal or the retreat at Dunkerque. Conflict neuroses were defined as developing after the slightest injury and under circumstances which were in no way frightening. In the conflict neuroses the "mere anticipation of an injury can bring about the same results as the injury itself." (Adler, 1945). The difference between the posttraumatic and other types of neuroses were viewed as consisting primarily of the fact that the catastrophic origin of the posttraumatic neuroses was relatively easy to trace. "In other types of neuroses the fundamental set-up and lack of positive interest in society is also present, but the development is often not so acute and may represent the result of an accumulation of problems." (Adler, 1945).
Vietnam
Regression has been commonly associated with war and postwar symptomatology. Posttraumatic symptoms have been considered regressive when manifested by chronic dependent behavior or outbursts of primitive, aggressive behavior. Recovery from regressive symptoms may in itself induce regressive experiences since recovery necessarily leads to another change in ego boundaries; rigid or fused boundaries becoming realigned, intact, and flexible. Recovery therefore requires a stable and trusting therapeutic relationship to gradually permit such changes. Psychological treatment of Vietnam veterans has often occurred in phases with immediate management of regressive symptoms occurring during early phases; induction of regressive states has often occurred during late phases to facilitate integration of "split-off" traumatic experiences and emotions (Brende, Colmery-O'Neill & McCann, 1984).
Brinson & Treanor(1988) propose that there is a much stronger correlation between alcohol-related problems and the symptomatology of posttraumatic stress disorder (PTSD) than has generally been recognized in clinical literature or in treatment programs for Vietnam veterans. They describe the world of the Vietnam veteran both while in the war and since returning home. Through a literature review, they establish a rationale why Vietnam veterans, especially those exposed to prolonged periods of heavy combat, are at-risk to develop alcohol-related problems. They examine the correlation between alcohol-related problems and the symptomatology of PTSD, demonstrating how they synergistically interact with each other, which exacerbates both the alcoholism and the readjustment problems of Vietnam veterans.
It is generally believed that military combat veterans of the Vietnam war suffer from a form of Post Traumatic Stress Disorder (PTSD), which is directly associated with a traumatic experience(s) related to war. In his research Alcaras (1995) departs from the notion that a traumatic event in and of itself changes forever the life of an individual. The purpose of his study was to examine military socialization, war trauma, the social learning dynamic, and the moral conflict within the social context of the Vietnam era as a powerful influence on the outcome of the Vietnam veteran's life experience. The phenomena of the Vietnam veteran's war experience (e.g. death, dying, killing, and general suffering) differs little from other veterans of other wars. How the war experience of the Vietnam veteran becomes defined by non-combatants, and more importantly how the veteran's response to the aftermath of war fall within the realm of mental illness appears to be more a function of the moral conflict surrounding the war than the effects of the war itself. Those behaviors which are attributed to PTSD (e.g. anger, rage, isolation, avoidant behaviors, intrusive recollection of the military and war, and a myriad of sleep disorders) are viewed by Alcaras as ego defense mechanisms developed in military training, war, and during the re-entry period. Hence, rather than seeing the veteran's life as a series of re-enactments of the trauma in an effort to 'make it right this time', the veteran's life experience is differentiated; some behaviors owed to trauma, others to military socialization and a form of psychological conditioning unique to military training during the Vietnam era (Alcaras, 1995).
Vietnam veterans fought a protracted, highly divisive war, and for that reason the Vietnam War and its veterans' representation in American culture remain contested. Brennan (1998) examined notable cultural representations of the veterans of the Vietnam War. He explored particularly how the phenomenon of Posttraumatic Stress Disorder (PTSD) was understood and treated by the military and psychological communities, and how that phenomenon was represented in the larger culture. The moral ambiguities of the Vietnam War required new therapeutic approaches to combat trauma which synthesized traditional psychological approaches with humanistic and spiritual models. For many Vietnam veterans, reintegration into a divided culture was painful and prolonged as a result of the war itself and the social and cultural perceptions of the soldiers who fought it. America's longest war and first military defeat, the Vietnam experience shattered the pre-war consensus of America's special mission and role in the world. Veterans of the Vietnam War were particularly vulnerable to many representations as they and their culture contested the meaning of the war and the image of the soldiers who fought it. Cultural artifacts such as memoirs, oral histories, novels, and films created during and after each war often suggested the perceptions held by soldiers of the profound life-changing effects of combat on its participants. These artifacts often provide a more penetrating awareness of war's effects on the human psyche and spirit than do the insights of the medical and psychiatric communities. The Vietnam War's unique place in American history required a new way of recognizing and treating combat trauma. Of necessity, Brennan (1998) explored the evolution of the military and psychiatric communities' understanding of battle trauma from the Civil War notion of nostalgia through the Vietnam War to the promulgation in 1980 of a new psychiatric diagnosis for post-war stress: Posttraumatic Stress Disorder. The changing perceptions of the causes of battle trauma and its effects as they were understood through the major U.S. wars of the twentieth-century thus provides the backdrop against which PTSD can be seen as a cultural and therapeutic phenomenon.
The Vietnam War was a highly relevant example of how societal-level issues can impact individual lives. An entire country and the world was involved in the conflict. The post-war had effects on those who served in the military at that time including the confusion and pain and continuing barriers to resolution of these difficulties.
Gulf War I
Unexplained symptoms have frequently been observed in deployed Persian Gulf War Veterans (GWVs). Using factor analysis, the Centers for Disease Control and Prevention (CDC) has established criteria for Gulf War illness (GWI). Baker, McQuarrie, Murray, Lund, Dashevsky & Mendenhall (2001) report on the prevalence of GWI, identify comorbidities, and compare these traits in 120 GWVs and veterans without GWI. Veterans with GWI were older; reported more combat exposure; scored higher on measures of depression, post-traumatic stress disorder, and fibromyalgia. They also had poorer health-related quality of life. More than half had anxiety or depressive disorders, and 93% had at least one medical and/or psychiatric diagnosis. The Medical Outcomes Study Short Form predicted mental health status with a positive predictive value of 81.58. By adding the Hamilton D rating for depression, the positive predictive value increased to 88.57. The CDC criteria accurately identified GWVs negative for GWI. Most GWVs were positive for GWI. Neither CDC criteria nor CDC severity rankings distinguish between veterans with psychiatric syndromes and those without. Both groups endorsed the same symptoms. More than half of those with GWI had a treatable anxiety or depressive disorder.
Bernstein and Kelley (Bernstein, Kelley & Fumento, 1998) claim that there are some 4 dozen disabling, sometimes life-threatening medical problems related to environmental and chemical exposure affecting thousands of soldiers who fought in the Persian Gulf War. Although the Pentagon denies it, Bernstein and Kelley argue that exposure to toxins is responsible for the illnesses experienced by the veterans of this war. Fumento (Bernstein, Kelley & Fumento, 1998) argues that the many illnesses suffered by Gulf War veterans have been attributed to the so-called syndrome without sufficient evidence. He blames veterans' health complaints on post-traumatic stress disorders rather than on exposure to environmental contaminants, and he faults the media for contributing to the hysteria.
Many times the general public associates aggression and violence with PTSD and/or combat veterans. The incidence of aggression and violent behavior in combat veterans varies and can be observed with regard to the presence or absence of post-traumatic stress disorder (PTSD). Begic & Jokic-Begic (2001) examined violent behavior in 116 male combat veterans (aged 22-45 yrs), 79 of whom had been diagnosed with PTSD. Their results show that a significantly greater occurrence of aggression was observed in combat veterans with PTSD compared with those without PTSD. There were various types of aggressive behavior that frequently are combined. Autoaggressive (suicidal) and heteroaggressive (interpersonal violence) behaviors predominate, with dominating verbal aggression and impulsive somatic reactions. Impulsive reactions are more frequently directed toward unknown persons, whereas verbal aggression is mostly aimed at known people. In the occurrence of aggressive behavior in combat veterans with PTSD, important roles are played by education level, low socioeconomic status, maltreatment in childhood, and previous types of violent behavior (before participation in war events). It is therefore important to account for pre-existing situations when assessing the possible causes and contributing factors to current adjustment behaviors.
The Israeli Experience
Bleich, Koslowsky, Dolev & Lerer (1997) examined psychiatric morbidity following war-related psychic trauma, with a special focus on the depressive comorbidity of post-traumatic stress disorder (PTSD). PTSD and psychiatric comorbidity were diagnosed using the Structured Interview for PTSD and the Schedule for Affective Disorders and Schizophrenia in 60 male Israeli veterans (aged 23-45 yrs) who sought psychiatric treatment 4-6 yrs after having been exposed to war trauma. Both lifetime (100%) and current (87%) PTSD were the most prevalent disorders. Comorbidity was extensive, with major depressive disorder most prevalent (95% lifetime, 50% current), followed by anxiety disorders, minor affective disorders, and alcoholism or drug misuse. Reactions in a group of Israeli soldiers during the 1973 Israeli-Arab War took the form of conversion hysteria in some cases, and of anxiety hysteria accompanied by nightmares in others. Concentrated psychotherapy, which was started immediately, led to self-awareness and complete recovery (Biran & Wertheimer, 1975).
Treatment and Prevention
Blake, Cook & Keane, 1992) examined psychological coping styles and mental health treatment histories in veterans with posttraumatic stress disorder (PTSD). Their study was also a replication and extension of an earlier investigation by D. D. Blake et al (1990) that assessed the prevalence of PTSD in World War II, Korea, and Vietnam combat veterans who were seeking medical treatment. 36 combat veteran medical patients were compared to 28 war-era controls. Nearly 33% of the combat veterans, but none of the controls, met psychometric criteria for PTSD. Both PTSD-positive Ss and mental health treatment seekers showed a significantly greater use of emotion-focused coping. Vietnam combatants were also more likely to have received individual mental health treatment.
SUMMARY
Each war or military conflict has slightly different effects due to a number of variables. However, the existing literature seems to suggest that there are some common adjustment factors that should be taken into account. Combat veterans returning from the Iraq War will likely have some specific adjustment problems among some members. These are likely to be dependent upon previous histories, combat experiences, previous combat experience, levels of training, presence or absence of adequate family support systems, and a myriad of other variables. Individual resilience, hardiness, personal expectations, levels of education, and personality factors will contribute to adequate return to equilibrium among returning combat veterans.
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REFERENCES Adler, A. (1945). Post-traumatic neuroses in war and peace. Individual Psychology Bulletin, 4, pp. 75-78.
Alcaras, David (Oct 1995). Military socialization during the Vietnam era: Differentiated aspects of trauma and conditioned responses. Dissertation Abstracts International Section A: Humanities & Social Sciences, Vol 56(4-A), pp. 1530.
Baker, Dewleen G., McQuarrie, Irvine G., Murray, Megan G., Lund, Linda M., Dashevsky, Boris A., Mendenhall, Charles L. (Nov 2001). Diagnostic status and treatment recommendations for Persian Gulf War veterans with multiple nonspecific symptoms. Military Medicine, Vol 166(11), pp. 972-981. Publisher URL: http://www.amsus.org/
Bartone, Paul T. (Spr 1999). Hardiness protects against war-related stress in Army Reserve forces. Consulting Psychology Journal: Practice & Research, Vol 51(2), pp. 72-82. Journal URL: http://www.apa.org/journals/cpb.html Digital Object Identifier: http://dx.doi.org/10.1037//1061-4087.51.2.72
Begic, Drazen & Jokic-Begic, Natasa (Aug 2001). Aggressive behavior in combat veterans with post-traumatic stress disorder. Military Medicine, Vol 166(8), pp. 671-676. Publisher URL: http://www.amsus.org/
Bernstein, Dennis, Kelley, Thea, Fumento, Michael (1998). Is the Gulf War syndrome real? In Nolen-Hoeksema, Susan (Ed); Clashing views on abnormal psychology: A Taking Sides custom reader. pp. 106-126.
Biran, S. & Wertheimer, D. (Apr-Jun 1975). Supplementary remarks on post-traumatic reaction. Zeitschrift fuer Psychosomatische Medizin und Psychoanalyse, Vol 21(2), pp. 179-181. Publisher URL: http://www.vandenhoeck-ruprecht.de
Blake, Dudley D., Cook, Jerome D. & Keane, Terence M. (Nov 1992). Post-traumatic stress disorder and coping in veterans who are seeking medical treatment. Journal of Clinical Psychology, Vol 48(6), pp. 695-704. Journal URL: http://www.interscience.wiley.com/jpages/0021-9762/
Bleich, Avi, Koslowsky, Meni, Dolev, Aliza & Lerer, Bernard (May 1997). Post-traumatic stress disorder and depression: An analysis of comorbidity. British Journal of Psychiatry, Vol 170, pp. 479-482. Journal URL: http://bjp.rcpsych.org/
Bonwick, Richard J., Morris, Philip L. P. (Dec 1996). Post-traumatic stress disorder in elderly war veterans. International Journal of Geriatric Psychiatry, Vol 11(12), pp. 1071-1076. Journal URL: http://www.interscience.wiley.com/jpages/0885-6230/
Brende, Joel O., Colmery-O'Neill & McCann, I. L. (Spr-Sum 1984). Regressive experiences in Vietnam veterans: Their relationship to war, post-traumatic symptoms and recovery. Journal of Contemporary Psychotherapy, Vol 14(1), pp. 57-75. Journal URL: http://www.wkap.nl/journalhome.htm/0022-0116
Brennan, Raymond Joseph (Dec 1998). Posttraumatic stress disorder in Vietnam veterans: Cultural representation and therapeutic models. Dissertation Abstracts International Section A: Humanities & Social Sciences, Vol 59(6-A), pp. 2079.
Brinson, Thomas & Treanor, Vince (1988). Alcoholism and Post Traumatic Stress Disorder among combat Vietnam veterans. Alcoholism Treatment Quarterly, Vol 5(3-4), pp. 65-82. Journal URL: http://www.haworthpressinc.com/store/product.asp?sku=J020
Chavigny (1930). La peur aux armees en campagne, sa medecine legale. Guerre de 1914-1918. (Fear in field armies and its medico-legal aspects. The war of 1914-1918.) Strasbourg Medical, 90, pp. 606-612; 621-626; 645-652; 705-711; 785-793.
To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
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RECOMMENDED READING
Counselling and Therapy with Refugees and Victims of Trauma: Psychological Problems of Victims of War, Torture and Repression, 2nd Edition
by Guus Van Der Veer, Guus Van Der Veer
Book Description
The well being of refugees displaced by war, disaster or repression is a concern of growing importance worldwide, but particularly in Europe and North American where mental health practitioners and services need special provision for them. This new edition covers the latest research on how to work with these special populations.
Editorial Reviews From Book News, Inc.
A guide for professionals in mental health and social work concerned with the care of refugees and other victims of political and military violence. Looks at methods for use with clients of all ages, within the context of major therapeutic approaches, and reviews supporting research. Discussion encompasses cultural differences, the therapeutic relationship, and treatment of crises and symptoms. This is a revised edition of , 1992. Book News, Inc.®, Portland, OR
Additional Readings at: Terrorism and Stress in the search engine. Also try looking here for Psychology and Terrorism.
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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